The Health, Social Care and Sport Committee is undertaking an inquiry into the health and wellbeing of children and young people, which the Scottish Government has identified as a public health priority.
This blog is a brief introduction to some of the key policies and issues surrounding the health and wellbeing of children and young people in Scotland.
Getting it right for every child
Getting it right for every child (GIRFEC) underpins Scottish Government policies that support children, young people, and their families. GIRFEC aims to support the wellbeing of every child. The Government has set out eight factors or aspects of wellbeing. These are that the child should be: safe, healthy, achieving, nurtured, active, respected, responsible and included. These areas of wellbeing are often called the SHANNARI indicators.
Public Health Scotland defines health inequalities as the “unjust and avoidable differences in people’s health across the population and between population groups.” Health inequalities are “socially determined by circumstances largely beyond an individual’s control” and create circumstances that “disadvantage people and limit their chance to live longer, healthier lives.” In March 2021, SPICe published a research briefing on health inequality and COVID-19 in Scotland. The briefing includes an introduction to health inequalities in Scotland and outlined health inequality before the pandemic.
Childhood experiences, like Adverse Childhood Experiences (ACEs), have been found to be a major determinant for future health outcomes. ACEs include experiences of abuse, neglect, or poverty during childhood.
The Health Foundation has noted the importance of adolescent and early adulthood in determining health outcomes, highlighting that a lack of adequate support during this transitional period “may lead to increased vulnerability for a young person.”
Health inequalities in Scotland have been reflected in recent research by the University of Glasgow, which detailed how care experienced children have poorer health outcomes. This included mental healthcare, where care experienced children were found to have a higher rate of prescriptions for depression, greater psychiatric outpatient clinic attendance, and increased acute inpatient admissions due to mental and behavioural disorders.
People who have experienced child poverty are more likely to have higher rates of adult mortality, physical disability, clinical depression, and premature death.
The Child Poverty (Scotland) Act 2017 requires Scottish Ministers to publish child poverty plans in 2018, 2022, and 2026. The delivery plan for 2018-2022 contains multiple commitments that target the impacts of child poverty on health outcomes, such as food poverty and insecurity.
The Scottish Government published a second year (2019-20) progress report in August 2020. Regarding food poverty and insecurity, it stated that around 260,000 children had received free school meal provision in 2018-19. The 2021-22 Programme for Government committed to fund free lunches for all primary school pupils from August 2022.
Physical health and wellbeing
The Schools (Health Promotion and Nutrition) Scotland Act (2007) ensures that all schools in Scotland are “health promoting”. It requires schools to provide food that meets national nutritional standards, which were recently updated through the Nutritional Requirements for Food and Drink in Schools (Scotland) Regulations 2020.
The Programme for Government 2021-22 made multiple commitments on children and young people’s physical health. The Scottish Government aims to halve childhood obesity by 2030 and “significantly reduce” diet-related health inequalities by delivering Scotland’s diet and healthy weight delivery plan.
The Scottish Government also committed to working with sportscotland on the next steps to “ensure that Active School programmes are free for all children and young people by the end of this Parliament”, which will increase the opportunities for participation in sport before, during, and after school.
The Scottish Government’s Mental Health Strategy, 2017-2027 made multiple commitments for child and adolescent mental health.
Audit Scotland’s 2018 report on children and young people’s mental health detailed the increasing pressures for children and young people’s mental health services in Scotland. Following Audit Scotland’s report, the Children and Young People’s Mental Health Taskforce was established in 2018. The Taskforce outlined their recommendations in July 2019, stating that “transformational change” would be required to improve children and young people’s mental health and the services that support them.
The Programme for Government 2020-2021 acknowledged the challenges still facing CAMHS. Too few NHS Boards were meeting the required targets for waiting-times and the impact of investment on performance was deemed to be “slowed and less comprehensive than expected and needed.”
The Scottish Government’s assessment is similar to Audit Scotland’s blog on Child and Adolescent Mental Health Services, published in August 2021. It found that, ultimately, “the picture today is similar to 2018, despite significant investment.”
The most recent CAMHS waiting times were published by Public Health Scotland in December 2021, for the quarter ending 30 September 2021. This showed that:
- 11,816 children and young people in Scotland are waiting to be seen by CAMHS, an increase from 9,699 people in September 2020.
- Of the 11,816 children and young people waiting to be seen, 56% had been waiting over 18 weeks.
- 3,792 children and young people were seen by CAMHS for the quarter ending September 2021.
- 78.6% of those seen in this quarter were seen within 18 weeks of a referral – an increase from 72.6% for the previous quarter and 60.6% for the quarter ending September 2020. However, this is still below the Scottish Government’s standard that 90% of children and young people should start treatment within 18 weeks of a referral to CAMHS.
The 2020 Independent Care Review identified a need for appropriate and timely mental health support for care experienced children and young people. COSLA and the Scottish Government’s Children and Young People’s Mental Health and Wellbeing Joint Delivery Board was set up in 2021 to oversee reform across education, health, community and children’s services.
The COVID-19 pandemic
The Scottish Government’s Coronavirus (COVID-19): mental health – transition and recovery plan acknowledged the “growing evidence” that the pandemic has had a particularly negative impact on children and young people’s wellbeing. SPICe published a research briefing on health inequality and COVID-19 in Scotland last year, which detailed the “age divide” of the pandemic’s indirect health harms. For example, young people are more likely to have suffered disruption to education through school, college, and university closures and are more likely to have been made redundant and placed on furlough.
Certain groups within the children and young people population have been more vulnerable to negative impacts on their wellbeing. A report by Public Health Scotland on early years found, for example, that children in affluent households were more likely to be doing well “psychologically and behaviourally” during lockdown than children in less affluent households. This research reflects findings for the wider population on how the pandemic has worsened existing inequalities, which the research briefing by SPICe explored in relation to health.
Actions identified in the COVID-19: mental health – transition and recovery plan will be supported by a £120 million investment during 2021-22. The Programme for Government 2021-22 detailed the intended impact of progressing the Mental Health Transition and Recovery Plan’s actions and its £120 million investment. Commitments included creating “transformational and lasting change” for CAMHS. This will be achieved by providing “sufficient funding” for around 320 additional staff over the next five years, with the aim of increasing the capacity of CAMHS cases by over 10,000.
Health and wellbeing in education
Health and wellbeing is a key part of the curriculum and is one of the three areas that is the responsibility of all staff to support; the other two being literacy and numeracy.
A key policy debate in recent years has been the quality of support for young people’s mental health in schools. Audit Scotland’s 2018 report found that mental health support provided within schools was varied.
The Scottish Government’s Mental Health Strategy, 2017-2027 included various recommendations for mental wellbeing in schools – including a review of Personal and Social Education (PSE), counselling services for children and young people, and improved mental health training for those supporting young people in educational settings.
In particular, the Scottish Government’s Programme for Government 2018-19 committed to investing over £60 million in additional school counselling services with the aim of ensuring that every secondary school in Scotland has counselling services. The Scottish Government published a summary report on access to counsellors in secondary schools in September 2021.
The Programme for Government 2021-22 committed to improving the mental wellbeing of students in higher education through the development of a student mental health action plan and the delivery of an additional 80 counsellors to universities and colleges over the next two years.
The Health, Social Care and Sport Committee’s Inquiry
Health inequalities in children and young people’s health and wellbeing that existed before the COVID-19 pandemic are now expected to worsen, in addition to the negative impact of the pandemic on children and young people’s wellbeing overall. Good health and wellbeing is vital to ensuring that all of Scotland’s children and young people “grow up loved, safe and respected” and can realise their full potential. The COVID-19 pandemic may make this more challenging to achieve. Health and wellbeing is likely to continue being a central area of the Scottish Government’s policies on children and young people, especially as the long-term impacts of the pandemic develop.
The themes and issues briefly outlined in this blog, as well as other topics, will be explored by the Health, Social Care and Sport Committee’s inquiry. You can keep updated on the inquiry via the Scottish Parliament’s website.
Cristina Marini, SPICe Trainee
Image by flickingerbrad is licensed under CC BY 2.0